Ask the Oncologist: Treatment for Prostate Cancer

Posted on February 6th, 2009 by

Question: Should I see a surgeon or a radiation oncologist for my localized prostate cancer?

Answer: You should see both a surgeon and a radiation oncologist before you decide on the specific type of treatment you will undergo for localized prostate cancer. Unless a patient presents with widespread prostate cancer, a urological surgeon is usually consulted to make the diagnosis. Currently in the United States , most prostate cancers are diagnosed following detection of an elevated prostate specific antigen (PSA). An elevated PSA prompts the primary care physician to refer such a patient to a urologist, who is a surgeon, for further examinations, which usually include a series of biopsies of the prostate gland. If prostate cancer is detected, the next step is to determine the extent of disease. If the disease is localized to the prostate and the immediate area adjacent to the prostate, the average patient with localized prostate cancer has to choose between total surgical removal of the prostate gland and radiation therapy.

The type of surgery performed for prostate cancer is called a radical prostatectomy and this is very effective in controlling prostate cancer depending on stage, PSA level and histology grade (Gleason score) of the cancer. The main side effects of a radical prostatectomy are urinary incontinence and erectile dysfunction.

Radiation therapy for prostate cancer can be delivered in two different ways. External beam radiation therapy is delivered from a machine outside the body. Brachytherapy refers to radiation that is delivered by “seeds” of radioactive isotopes implanted in the prostate to deliver slow doses of radiation to the cancer. Sometimes external beam radiation is combined with brachytherapy. Radiation therapy may be associated with less urinary dysfunction and erectile dysfunction than surgery, but these side effects still occur. Radiation therapy also causes temporary damage to the lower bowel, which receives radiation.

In younger, healthy patients with localized prostate cancer, surgery and radiation therapy appear to produce similar anti-cancer effects. Unfortunately, there have no randomized controlled trials comparing the two treatments and none are currently being carried out or planned. Younger patients with localized prostate cancer and no significant medical problems will usually be advised by a urologist to have surgery. The same patient would be advised by a radiation oncologist to receive radiation therapy. Thus, a patient must get information from both types of physicians and make up their own mind about treatment.

Some patients who are in poor medical condition are advised to have radiation therapy instead of surgery, as general anesthesia and extensive surgery can be associated with more life-threatening side effects than radiation therapy.